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PLEASE PRlI\IT: <br />Date 7-7 -.;2.016 <br />To:San Joaquin County <br />.Department of Public Works <br />1P1F-,~.~i\C(7b LI~5~~ <br />IAppli(;~1i1"~am8) <br />t{tJ 1CJ vJ esl:L.!tN:" <br />(Mainirl!J Allidr<;ss) <br />~t &c.}c..-to ",iY\q .b-.:::?()<i <br />ICili SI~18.Zij1lCo!ile) <br />(LoQ)3?-q';>r><cl::z€,e,C!bA <br />(Are~Code.Ieiej1ll1olle NilrnlJer' <br />Slmtch (Detailed plans may be submitted) <br />OFFICE USE ONLY <br />JOB#'13{J()~'dA.••REF# <br />APN CR# <br />EXP.DATE Ii /'/'& <br />DRIVEWAYS:VAliD.~llloo ~v <br />*STREET ~h RC[. <br />.',REA ~"<-~6.J QUAD 4f , <br />TYPE ~t,:~jf/~~, <br />FORMS <br />NOTES , <br />.The undersigned hereby applies for permission to excavate,construct end/or otherwise encroach on COj!nty Highwa Righi-of-Wayon <br />the IJ side of A-r vl>\.0;[..approximaiely /..[;emile uJ <br />of AIL(.ft,:"M ,>t:O(';..t<:t6i~,byperformingihefollowingwork escriptionofwork):f?.e-pku::-e.'De'ferfnr-de.-l!fb Ie IlJ '£I s <I'i Sf dr<!.-h &1.t <br />Work wiJIcommence on or aboul '7 -.:z 0 -'"()16 for approximately :::z.days. <br />.I;END 1t-..40-~O(6 ' <br />I,the undersigned,certify that i am the owner of the respective property,or am qualified to represeni ihe owner and egree to do the <br />work described ebove in accordance with the rules and regulations of San Joaquin County and subject to inspection and approval. <br />~l\CENJRAlSER\JICES\GLERiCAl.\PUEl.sV.\Vl(1.,lASTEftPSlEtICROACHMENTPERMIT"APPLICATIOiWOC (lI.!f13)